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Dextranomer Endoscopic Injections for the Treatment of Urinary Incontinence in Bladder Exstrophy-epispadias Complex
Venusia Fiorenza1, Maria Hukkinen1,2, Ilona Alova1
1Department of Pediatric Surgery and Urology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France.
Insights
Dextranomer/hyaluronic acid copolymer (Deflux) injections improved urinary incontinence in over half of children with bladder exstrophy-epispadias complex. Success rates varied by sex and prior bladder neck reconstruction, with better outcomes in males and after reconstruction in females and exstrophy patients.
Area of Science:
- Pediatric Urology
- Reconstructive Surgery
- Urodynamics
Background:
- Urinary incontinence is a common challenge in children with bladder exstrophy-epispadias complex.
- Dextranomer/hyaluronic acid copolymer (Deflux) is a minimally invasive treatment option for urinary incontinence.
Purpose of the Study:
- To evaluate the efficacy of dextranomer/hyaluronic acid copolymer injections for urinary incontinence in children with bladder exstrophy-epispadias complex.
- To identify predictors of treatment success in this patient population.
Main Methods:
- Retrospective analysis of 58 children with bladder exstrophy-epispadias complex who underwent Deflux injections between 1997 and 2021.
- Assessment of continence status (dry, improved, failure), complications, and bladder capacity.
- Kaplan-Meier analysis for failure-free survival, considering sex and prior bladder neck reconstruction.
Main Results:
- 58 patients underwent 105 Deflux injections; 9% experienced complications.
- Five-year failure-free survival was 70% in male epispadias versus 45% in female epispadias and bladder exstrophy patients (P=.04).
- Prior bladder neck reconstruction improved survival in females and exstrophy patients (58%) but not in male epispadias (75%).
Conclusions:
- Dextranomer/hyaluronic acid copolymer injections offer a satisfactory and durable solution for urinary incontinence in over half of bladder exstrophy-epispadias complex patients.
- Treatment success in male epispadias was independent of prior bladder neck reconstruction.
- Previous bladder neck reconstruction was associated with better outcomes in bladder exstrophy and female epispadias.
Purpose:
Since bladder neck dextranomer/hyaluronic acid copolymer (Deflux) injections can improve urinary incontinence of various etiologies, we hypothesized that incontinent children with bladder exstrophy-epispadias complex would benefit from dextranomer/hyaluronic acid copolymer. We aimed to analyze dextranomer/hyaluronic acid copolymer efficacy and predictors of treatment success in bladder exstrophy-epispadias complex.
Materials And Methods:
Incontinent bladder exstrophy-epispadias complex children aged >4 years undergoing dextranomer/hyaluronic acid copolymer injections in our hospital between October 1997 and January 2021 were included. Medical history, continence, and bladder capacity before injections were recorded. Postoperatively, patients were categorized as "dry," "significantly improved," or "failure." Postoperative complications, bladder emptying mode, and bladder capacity were reported. Failure-free survival was estimated by Kaplan-Meier models.
Results:
Altogether, 58 patients (27 male epispadias, 9 female epispadias, 22 bladder exstrophy) underwent 105 injections at median age of 8.5 (interquartile range 5.8-12) years. Previous bladder neck reconstruction had been performed in 38 (66%) and 33 (57%) received multiple injections. Complications occurred in 9%. Five-year failure-free survival was 70% (standard error 9.1) in males epispadias compared to 45% (9.0) in females and exstrophy patients (P = .04). Previous bladder neck reconstruction associated with improved 5-year failure-free survival in females and exstrophy patients (58%, SE 11) but not in male epispadias (75%, SE 11).
Conclusions:
Dextranomer/hyaluronic acid copolymer injections provided satisfactory and lasting continence in over half of bladder exstrophy-epispadias complex patients. While injections were successful in male epispadias regardless of bladder neck reconstruction timing, results were better in bladder exstrophy and female epispadias after previous bladder neck reconstruction.
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